Provider Demographics
NPI:1437579109
Name:WONG, DAVID YICK LEUNG (ATC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:YICK LEUNG
Last Name:WONG
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:MR
Other - First Name:I-LIANG
Other - Middle Name:
Other - Last Name:HUANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:65 CHANG AN EAST ROAD, SECTION 2
Mailing Address - Street 2:4/FL.
Mailing Address - City:TAIPEI
Mailing Address - State:CHUNG SHAN PROVIDENCE
Mailing Address - Zip Code:10455
Mailing Address - Country:TW
Mailing Address - Phone:88693-593-6635
Mailing Address - Fax:
Practice Address - Street 1:7822 DEER MEADOW DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-4414
Practice Address - Country:US
Practice Address - Phone:916-421-4176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0000802722255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer